HomeMy WebLinkAbout20150032 Ver 1_Shoreline Stabilization_20150109D
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"Division of Watev Resources
2 0 1 5 0 0 3 2 State it McrSw CzraWw
Department of Environment and Natural Resources
Division of tlt*w Resources
15A NCAC 02H .0500 — water Quality Certification, Shoreline Stabilization
FC2VA: SSGP 10-201B
Sh •�relinr Stab;iiMatV. A.Q�plic3tton Form
F 6?1.1 f Cw �Ti d' S !i)•f tt�} ]eC'Q' -'J ' " I fl
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M: & ftockv r Mmrttinh unit
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I. &Wkant OnftMad as 115A NCAC 02H 0502(x)]
1. Owner
Name:
Mailing
Telephone Number: Z,_ VD 7�5 Eaus Number: ,�f S �� r
E -mail Address: of f- D1j?de fO A v /'C 1t�wL_l i' -- -
2 Agent/ Contact Person Infbrmation
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here
httn.l /wwwsaw,usace.army.i, nil / Portals/ S9/ docs/ reaulatory lregdocs /i)errnits(SAMPLE AGENT AUTH
ORIZATJON FORM,pd j must be attached if the Agent has signed this application forme
Name: l��J*—A )IA3 &glVi E.af, (, 9e�83 aOG/�� SCif-c�►.g-f,(._ CO,
Company Affiliation:
Bailing Address:
a cvS-P,
- ?.D�ai)y'.,4
Telephone Number: —4D4 Eau Number: 62-0 -7q3-&Z_40
E -mail Address:
Person to receive the Certification Approval: r,.& V- At v
ll. PMT OfiftTM50= (15A NCAC 0211 .0502(a) & (b) ]
1 Attach a vicinity map (i e, street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads
2 Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10.2013 Page 1 of 4
etc ), rip rap, excavation or dredging below Full Pond / Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a ply of the shoreline/ buffer proposed to be stabilized. (include a scale
of some sort- a yard stick, shovel handle, etc.)
4 Location of the property (where work is to be conducted) r
County: LDjaW'3 Nearest Torn:
Subdivision name or site address (include phase /lot number):
5`I 0 4f,- QRLLD &� ]-+T• 3.5.16 S 1 6 k � ^i b -- -Fr3 t� � 7 „
Directions to site - please Include road names and numbers, landmarks, etc.: ► Ci9`stil���
) AC>✓ ( ®7 Af T� Jy O � y�1 G� P 6 v4 L Q:: F i � L LG Y c1
61+N �Q .Sc��'► r� 1 �.�1-1 .' IEN t+�wC,3E C3 �I fZ 1 Lv-H i
o L3 AM D l P .A b X-1) 0-1 &HE m F !-,
5. Describe the existing land use or condition of the site at the time of this application_
(residential, undeveloped, etc): JZ4tg--oLhW6N A% Dt) S ��YiG7 �� sr'VGiJc�!
b. Property size (acres): t aca
7. Lake/ river/ ocean adjacent to property: _,4,f Kf- G=L tJ 1,L
8. Describe proposed work (include discussion as to how hardening of shoreline has been
04i
avoided, or why it is necessary): JP O S�IJ -!3
„ Cl-i� St- l'D�.��� L)P-fY
4. Will work be conducted from land? ❑ From water?
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc )
below the normal pool lake level/ Normal Water level in square feet or acres:
11 Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ normal Water Level and 50 feet land -ward in
square feet ov acres: - 7� -
12. Please describe the vegetation above the normal pool lake level/ Formal Water Level and
50 feet landward to be impacted (number of trees, for instance): 7144knF-
TIZfc.�S $ —iD �' / D( E,�2 LQW1-ZQ- 0TVA V
tM o s-i-�- y G2#-93 q- LcNC- Sr4o�..
Owner /Agent's Si �fd ' [15A t�CAC 02H .OSOZ(f l Date
Agent's Signature is nly if an authorization letter from the owner is provided
FORM SSGP 10.2013 Page 2 of 3
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Home )> Lake Glenville, NC Area Map
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